Global Health Learning Research Articles

Global health education in the Dutch Caribbean: 50 years of a unique Groningen-Curaçao clinical clerkship program

The globalization of healthcare has had a significant impact on healthcare delivery and human workforce development in many countries. Consequently, many educational institutions have had to revise the content of their medical curricula to focus on training and preparing future doctors to effectively cater to the needs of the “modern patient”. The focus covers broader aspects of medicine that include environmental and professional culture and the impact of socioeconomic inequalities on the delivery of healthcare. Therefore, in most global health (GH) education programs described, students undertake a specific part of their clinical rotation in a foreign (non-western) educational setting to facilitate authentic learning experiences within a resource-constrained environment. In this paper we present a unique Global Health program for medical interns between the University Medical Center Groningen, Netherlands and the Sint Elisabeth Hospital, Curaçao, Dutch Caribbean that has, for more than 50 years, been providing a one-year internship program as part of the formal Groningen curriculum. The program we describe, illustrates the essential requirements for best practice in GH education that fully complies with recently proposed GH program objectives and competencies. The characteristics of our long running program show the basic requirements necessary for sustainable and successful health education collaboration between institutions in high- and low/middle income countries. Finally, this program, which is part of a Dutch medical curriculum, not only provided unique global health learning experiences for the interns, but importantly also contributed to improving the general healthcare delivery services on the island of Curaçao as well.

Global Health Learning Outcomes by Country Location and Duration for International Experiences

Objective. To determine the impact of country income classification and experience duration on learning outcomes for student pharmacists participating in international advanced pharmacy practice experiences (APPEs). Methods. A mixed-methods, longitudinal study evaluated 81 fourth-year student pharmacists participating in an international APPE through one of three US universities. A pre-post survey was administered to evaluate students' self-perceived growth across 13 competencies established by the Consortium of Universities for Global Health (CUGH). The survey included four additional open-ended questions. Student pharmacists were also invited to participate in a focus group. Paired and independent t tests and multiple linear regression were conducted. Qualitative survey and focus group data underwent a two-cycle, open-coding process using conventional content analysis. Results. Students who completed their APPE in a low- to middle-income country had greater growth in all CUGH competency statements compared to those who completed their APPE in a high-income country. Completing the APPE in a low- to middle-income country and prior travel for non-vacation purposes were significant predictors of student growth. Students who went to a low- to middle-income country demonstrated increased cultural sensitivity, more patient-centered care, and skill development, while students who went to a high-income country displayed increased knowledge regarding differences in health care system components, pharmacy practice, pharmacy education, and an appreciation for alternative patient care approaches. Conclusion. Learning outcomes differed between students who completed an APPE in a high-income rather than a low- to middle-income country, with both types of locations providing valuable educational opportunities and professional and personal development.

Integrating Competency-Based Didactic and Experiential Global Health Learning for Dental Students: The Global Health Learning Helix Model.

The aim of this study was to evaluate the feasibility and preliminary outcomes of immersive integrated experiential and didactic courses in strengthening competency-based global health learning in dental education. To address global inequities in oral health and student interest in global health, the Harvard School of Dental Medicine introduced two global health courses in 2017-18. The first was a didactic course in the core predoctoral curriculum, and the second, in collaboration with the Inter-American Center for Global Health, was a five-day elective experiential learning course in rural Costa Rica. The experiential course was an extension of the didactic course. All 33 second-year dental students completed the didactic course, and three of those students completed the experiential course. A pre-post survey and a six-month follow-up survey on self-reported knowledge based on course learning objectives were administered. The experiential course students also completed journals and interviews for qualitative analysis. Thirty-two students completed the pre-post didactic course surveys, for a response rate of 94%. There was a 100% response rate on the pre-post didactic surveys by those students who participated in the experiential learning course. While the experiential learning group scored similarly to the class average before the didactic course, they had higher scores than the class averages both immediately after and at the six-month follow-up. All three students reported that the experiential learning course was "extremely effective" in building on what they learned in the didactic course. Qualitative analysis of the journals and interviews suggested enhanced learning from the combination of didactic and experiential methods. These preliminary results support the Global Health Learning Helix Model, a theoretical competency-based teaching model for ethical student global health engagement to better prepare the future generation in tackling oral health disparities both locally and worldwide.

Global Health Learning Outcomes in Pharmacy Students Completing International Advanced Pharmacy Practice Experiences

Objective. To examine the global health learning outcomes of Doctor of Pharmacy (PharmD) students from three US schools who participated in international advanced pharmacy practice experiences (APPEs). Methods. A mixed-methods, prospective study was used to assess fourth-year PharmD students at three US pharmacy schools who participated in an international APPE during the 2017-2018 academic year and a matched cohort (control group) of PharmD students who did not participate in an international APPE. To evaluate students' self-perceived growth in the Consortium of Universities for Global Health (CUGH) competencies, all students completed a 13-item retrospective pre-post instrument using a five-point Likert scale. The students who had completed an international APPE were invited to participate in a focus group (N=22). Paired and independent t tests and multiple linear regression were used to analyze data. Qualitative open-ended questions and focus group data were mapped to knowledge, skills, and attitudes themes. Results. The students who completed an international APPE (N=81) showed significantly more growth in CUGH competencies than students who did not (mean improvement in total score of 10.3 [7.0] vs 2.4 [6.0]). International APPE participation was the only significant predictor of growth in CUGH competencies. The international APPE students reported improvements in cultural awareness and appreciation, communication skills, problem-solving skills, adaptability, self-awareness, personal and professional outlook, and global health perspective. Conclusion. Pharmacy students' participation in international APPEs led to significant improvement in all CUGH competencies. The CUGH competency framework appears to be a suitable instrument to assess pharmacy students' global health learning outcomes.

Developing an Open Access, Competency-Based Global Oral Health Curriculum: A Global Health Starter Kit.

Dental education has seen increases in global health and international educational experiences in many dental schools' curricula. In response, the Consortium of Universities for Global Health's Global Oral Health Interest Group aims to develop readily available, open access resources for competency-based global oral health teaching and learning. The aim of this study was to develop and evaluate a Global Health Starter Kit (GHSK), an interdisciplinary, competency-based, open access curriculum for dental faculty members who wish to teach global oral health in their courses. Phase I (2012-17) evaluated longitudinal outcomes from two Harvard School of Dental Medicine pilot global health courses with 32 advanced and 34 predoctoral dental students. In Phase II (2018), the Phase I outcomes informed development, implementation, and evaluation of the open access GHSK (45 enrollees) written by an interdisciplinary, international team of 13 content experts and consisting of five modules: Global Trends, Global Goals, Back to Basics: Primary Care, Social Determinants and Risks, and Ethics and Sustainability. In Phase III (summer and fall 2018), five additional pilot institutions (two U.S. dental schools, one U.S. dental hygiene program, and two dental schools in low- and middle-income countries) participated in an early adoption of the GHSK curriculum. The increase in perceived knowledge scores of students enrolled in the pilot global health courses was similar to those enrolled in the GHSK, suggesting the kit educated students as well or better in nearly all categories than prior course materials. This study found the GHSK led to improvements in learning in the short term and may also contribute to long-term career planning and decision making by providing competency-based global health education.

Global Health Opportunities in Pediatric Fellowships.

Interest in global health (GH) among pediatric residents continues to grow. GH opportunities in pediatric fellowship programs in the United States are poorly described. We aimed to evaluate GH offerings among accredited general and subspecialty pediatric fellowship programs and identify implementation barriers. This was a cross-sectional study by pediatric GH educators from the Association of Pediatric Program Directors Global Health Learning Community and the American Board of Pediatrics Global Health Task Force. Fellowship program directors and GH educators at accredited US pediatric fellowship programs were surveyed. Data were analyzed by using descriptive and comparative statistics. Data were obtained from 473 of 819 (57.8%) fellowship programs, representing 111 institutions. Nearly half (47.4%) offered GH opportunities as GH electives only (44.2%) or GH tracks and/or fellowships (3.2%) (GHT/Fs). Pretravel preparation and supervision were variable. Programs offering GH opportunities, compared to those without, were more likely to report that GH training improves fellow education (81.9% vs 38.3%; P < .001) and recruitment (76.8% vs 35.9%; P < .001). Since 2005, 10 programs with GHT/Fs have graduated 46 fellows, most of whom are working in GH. Of those with GHT/Fs, 71% believe national accreditation of GH fellowships would define minimum programmatic standards; 64% believe it would improve recruitment and legitimize GH as a subspecialty. GH experiences are prevalent in accredited US pediatric fellowship programs, and programs offering GH perceive that these opportunities improve fellow education and recruitment. Responses suggest that standards for GH opportunities during fellowship would be useful, particularly regarding pretravel preparation and mentorship for trainees.

Leveraging Economies of Scale via Collaborative Interdisciplinary Global Health Tracks (CIGHTs): Lessons From Three Programs.

As interest in global health education continues to increase, residency programs seeking to accommodate learners' expectations for global health learning opportunities often face challenges providing high-quality global health training. To address these challenges, some residency programs collaborate across medical specialties to create interdisciplinary global health residency tracks or collaborative interdisciplinary global health tracks (CIGHTs). In this Perspective, the authors highlight the unique aspects of interdisciplinary tracks that may benefit residency programs by describing 3 established U.S.-based programs as models: those at Indiana University, Mount Sinai Hospital, and the University of Virginia. Through collaboration and economies of scale, CIGHTs are able to address some of the primary challenges inherent to traditional global health tracks: lack of institutional faculty support and resources, the need to develop a global health curriculum, a paucity of safe and mentored international rotations, and inconsistent resident interest. Additionally, most published global health learning objectives and competencies (e.g., ethics of global health work, predeparture training) are not discipline specific and can therefore be addressed across departments-which, in turn, adds to the feasibility of CIGHTs. Beyond simply sharing the administrative burden, however, the interdisciplinary learning central to CIGHTs provides opportunities for trainees to gain new perspectives in approaching global health not typically afforded in traditional global health track models. Residency program leaders looking to implement or modify their global health education offerings, particularly those with limited institutional support, might consider developing a CIGHT as an approach that leverages economies of scale and provides new opportunities for collaboration.

Global Health Education in UK Medical Schools (GHEMS) study protocol

# Background Global health is the study, research, and practice of medicine focused on improving health and achieving health equity for all persons worldwide. Such focuses are core tenets of modern medical practice. The General Medical Council (GMC) have published several documents that outline specific global health learning outcomes and competencies that are essential, non-elective components of UK medical school curricula. However, there is a paucity of evidence demonstrating that medical schools have integrated these mandatory global health learning outcomes within their curricula. This multicentre study aims to delineate the breadth of global health teaching during undergraduate and graduate entry medical training across UK medical schools. # Methods This national, multi-centre study will involve obtaining timetables containing details of all medical teaching provided at undergraduate and/or graduate entry level at UK medical schools for the academic year 2018/2019. Collaborators at each centre will independently code all timetabled global health learning events (compulsory, optional, or pre-elective), conforming to a pre-devised standard framework that will enable description of teaching events in terms of course year, duration, teaching format, and teaching content. The quantitative and qualitative data will be analysed using descriptive statistics and thematic analysis, respectively. Krippendorff's alpha coefficient will also be utilised to measure the level of agreement between datasets collected independently by different collaborators at the same centre. # Results This study will define, for the first time, the nature and characteristics of global health education within UK medical school curricula. It will capture any differences in the amount of teaching provided on various global health learning outcomes between medical schools. # Conclusions If this study depicts national discrepancies in teaching, it will place the onus on medical schools and the GMC to provide standardised and adequate global health education within the undergraduate and graduate entry medical curriculum. To aid medical schools in achieving this, the study will also identify currently scheduled teaching events at each medical school that could incorporate material related to the mandatory global health learning outcomes.

Facilitating Critical Self-Exploration by Global Health Students.

Much has been written about the need for participants on global health service-learning experiences to contemplate ethical features of their involvement. This literature tends to neglect the role of self-interest in global engagement, however. This article explores how awareness of one's own interests is critical to successfully engaging in global health experiences and proposes how US-based health professions students and trainees can practice critical self-exploration. Six themes beginning with the letter I (identity, ideology, ignorance, imagination, intention, and investment) are introduced as guides to nourish conscientious, collaborative global health learning and practice.

"The World Is Our Campus": Student Satisfaction With an International Nursing Education Partnership.

The purpose of this study was to explore nursing students' perceptions of global health experiences from an international partnership. Nursing organizations have identified global health care as core knowledge. To address global health care competencies and culture awareness, activities were designed by nursing faculty in Finland and the United States. A mixed-method questionnaire was given to 111 students. Data suggest contact with international nursing peers and learning activities increased understanding of health issues in another culture and increased student self-confidence and communication. Developing a partnership between nursing schools can result in positive global health learning experiences for students.

African Forum for Research in health (AFREhealth) student exchange pilot: an impact assessment

Abstract Background For many medical and allied health students from African countries, the opportunity to undertake a global health elective abroad is unaffordable or inaccessible. Therefore, an imbalance has emerged where many African institutions host students from developed countries but their own students rarely go on electives in developed countries. Global Educational Exchange in the Medical and Health professions (GEMx), a service programme of the Educational Commission for Foreign Medical Graduates (ECFMG) partnered with the African Forum for Research in Health (AFREhealth) to implement a south-to-south student exchange pilot through intra-institutional partnerships. The aim was to provide affordable global-health learning opportunities to African students. Methods 13 medical and nursing institutions in eight African countries participated in the AFREhealth pilot. Institutions entered into a multilateral agreement. The GEMx web-based system was used to centralise elective placements where students gained access to opportunities and applied online. Host institutions waived their administrative fees and provided a manager to support incoming students. ECFMG hired a contractor to do partnership development and work with students and leaders at participating institutions. ECFMG GEMx provided student mini-grants to cover travel, accommodation, and living expenses. We used SurveyMonkey to collect feedback from students, institutions, and AFREhealth leadership and to run descriptive analysis. Findings Between April, 2017, and June, 2018, GEMx facilitated 48 student exchanges in medicine, nursing, and pharmacy in Ghana, Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. 20 students (42%) reported that they had not previously gone on an elective exchange in another country and that this opportunity would not have been possible without GEMx. The most common learning experiences reported by institutions were that students: learned about and compared different health systems; improved clinical skills and gained knowledge that is applicable back home; increased confidence; developed professional networks; and managed and cared for patients who differed from those in their previous educational experience. These findings correlated with feedback collected from students. Interpretation Translation and implementation for impact in global health requires models that provide opportunities for global exposure to various health-care settings. With little global exposure for African medical and allied health professional training students, the south-to-south model provides a suitable and cost-effective platform to address the gap. Outcomes from the pilot showed a strong commitment from intra-institutional partners within AFREhealth to the south-to-south model. Although ECFMG GEMx funding made student exchanges possible for the AFREhealth student exchange pilot, additional funding contributions are needed to expand the south-to-south student exchange programme. Funding ECFMG Challenge Grant.

Global Health Education and Advocacy: Using BMJ Case Reports to Tackle the Social Determinants of Health.

Since 2013, BMJ Case Reports (http://casereports.bmj.com/) has published over 70 global health case reports from five continents, written by doctors, nurses, students, and allied health professionals. These cases, a burgeoning repository of evidence of how real patients are affected by disease, trauma, violence, sexual assault, conflict, migration, adverse living and working conditions, and poor access to health care, discuss, in addition to clinicopathological findings, the global health problems affecting each patient. The global health problem analysis examines the problems of individual patients, critically appraises the literature, and describes actual and potential solutions for the patient, the local community, and patients affected by similar issues across the world. At present global health literature and learning materials lack a patient focus and real-life context in the analysis of global health problems. BMJ Case Reports global health case reports are a unique and important tool to learn about and advocate for change in the social, political, cultural, and financial determinants of health as they affect real patients. This growing evidence base brings together clinicians, local service providers, policy makers, and government and non-governmental institutions to effect real change in patients’ lives toward improving health. Each global health case report is an excellent resource for learning, and together, these case reports provide essential reading for anyone embarking on a career in global health, and writing their own case report. The online course (http://casereports.bmj.com/site/misc/GHMA_Mar_2017.pptx) at BMJ Case Reports uses these cases and is free to access.

A Teaching Strategy to Facilitate Nursing Students’ Translation of Global Health Learning from Classroom to the Community

ABSTRACTIntegrating global health concepts in nursing curricula is important for a competent contemporary global nursing workforce. This article describes a teaching strategy that facilitates students’ translation of global health content from classroom to the community. A community–academic partnership and a train-the-trainers’ approach to support community capacity for working with refugees was implemented. The Community-As-A Partner model was used as the guiding framework. Additionally, the DEAL model was used to support students’ reflections on their clinical experiences. A quiz, reflections, participant evaluations, and student peer evaluations were used to assess students’ clinical learning experiences. Key lessons learned are also presented.

Constructing a Global Learning Partnership in Physiotherapy: An Ireland-Uganda Initiative.

There is a strong correlation between disability and poverty and it is acknowledged that until disability issues are addressed, the goal of poverty reduction in low-income countries is unlikely to be achieved. Despite the high prevalence of disability in developing countries, there remains a significant shortage of rehabilitation professionals as highlighted by the WHO report, Human resources for Health (2006). The purpose of this project was to develop a collaborative and sustainable partnership to strengthen educational and research capacity in global health, disability, and rehabilitation between two physiotherapy schools; University College Dublin, Ireland, and Mbarara University of Science and Technology, Uganda. This article aims to describe the approach used and initial project outcomes. This project involved a bilateral visit to both institutions by two members of staff of respective physiotherapy programs. These visits entailed stakeholder meetings, clinical site visits, and workshops to identify the priorities for the partnership and shape the collaboration going forward. Appreciative inquiry methodology was used during the workshops and the four-dimensional framework for curriculum development was used to guide analysis and underpin findings. The key priorities identified were (i) development of joint global health learning initiative, (ii) to explore the possibility of postgraduate learning and research opportunities for Ugandan colleagues, and (iii) to develop joint clinical placements. The rationale and context and a plan of action is described. The project is ambitious and in order to be sustainable, the importance of long-term interinstitutional commitment and further funding cannot be ignored. This work provides a framework for other universities and institutions wishing to undertake similar activities. Such partnerships provide rich learning opportunities for students and health professionals and facilitate a deeper understanding of global health issues, social and cultural health determinants, and development of enhanced professional skills.

Simnovate: simulation, innovation and education for better healthcare

Simulation has already transformed medical education, and holds the power to shape modern healthcare systems, communities and populations. Simnovate is a mission, a community and a partnership of passionate, driven and game-changing individuals, who wish to see the change we can make together, in the world, right now. Four domains were defined: patient safety, medical technologies, global health and pervasive learning, with domain group experts that span healthcare simulation, outcomes research, aviation, serious gaming, patient safety, economics, machine learning, biorobotics, implementation science, global health and the visual arts. Bringing together simulation, innovation and education, for better health and care.

Global Health Learning - Are Students Demonstrating Insights Through Short Essays?

This article was migrated. The article was marked as recommended. Background Aim: Learning outcomes (LO) for Global Health (GH) in medical curricula were developed by consensus. This discipline however is challenging to deliver. In one medical school we explored evidence of learning following symposia, by qualitatively analysing essays and data from student feedback. Methods: A purposive sample of 14% (N=58) GH essays, from senior medical students, were analysed for content, as they related to these LOs, the critical insights and arguments around GH. Free text student feedback data was analysed for student acceptability of the assignment, given that this contributes to students' final ranking. Results: A synthesis of themes were identified suggesting good awareness of the interconnectivity of health issues, such as health care systems and social determinants of health. A minority of students restricted themselves to descriptive essays. A quarter of students explicitly linked their essays to their forthcoming elective placement enabling them to feel well informed about local health issues regardless of whether they were going to a resource poor setting or not. Many students valued this assignment, but a minority disliked the lack of prescriptive directive. Conclusions: These approaches to GH teaching and assessment demonstrated learning for most students, and good scholarship in many essays, for this essential but emerging discipline.

Framework for interprofessional education (IPE) to advance global health learning

Welcome to Annals of Global Health,Annals of Global Health is a peer-reviewed, fully open access, online journal dedicated to publishing high quality articles dedicated to all aspects of global health. The journal's mission is to advance global health, promote research, and foster the prevention and treatment of disease worldwide. Its goals are to improve the health and well-being of all people, advance health equity, and promote wise stewardship of the earth's environment. The latest journal impact factor is 3.64.Annals of Global Health is supported by the Program for Global Public Health and the Common Good at Boston College. It was founded in 1934 by the Icahn School of Medicine at Mount Sinai as the Mount Sinai Journal of Medicine. It is a partner journal of the Consortium of Universities for Global Health. Authors of articles accepted for publication in Annals of Global Health will be asked to pay an Article Publication Charge (APC) to cover publication costs. This charge can normally be sourced from your funder or institution. We are committed to supporting authors from all countries to publish their work in Annals of Global Health regardless of national income level, and to achieve this goal, we waive the Article Publication Charge for manuscripts where all authors are from low-income or lower-middle-income countries (as defined by the World Bank). From time to time, Annals of Global Health publishes Special Collections, a series of articles organized around a common theme in global health. Recent Special Collections have included “Strengthening Women’s Leadership in Global Health”, “Decolonizing Global Health Education”, and “Capacity Building for Global Health Leadership Training”. Global health workers interested in developing a Special Collection are strongly encouraged to contact the Managing Editor in advance to discuss the project.

Global Health Care: Implications for Nursing

Nurses are responding to global health care crisis needs by providing care to diverse populations while expanding their understanding of cultural, economic, political, social, and environmental factors impacting healthcare. Educational institutions are placing emphasis on global health learning and providing international experiences for nursing students to view population health beyond borders increasing knowledge of health determinants alongside their global nursing counterparts.

Introducing global health into the undergraduate medical school curriculum using an e-learning program: a mixed method pilot study.

BackgroundPhysicians need global health competencies to provide effective care to culturally and linguistically diverse patients. Medical schools are seeking innovative approaches to support global health learning. This pilot study evaluated e-learning versus peer-reviewed articles to improve conceptual knowledge of global health.MethodsA mixed methods study using a randomized-controlled trial (RCT) and qualitative inquiry consisting of four post-intervention focus groups. Outcomes included pre/post knowledge quiz and self-assessment measures based on validated tools from a Global Health CanMEDS Competency Model. RCT results were analyzed using SPSS-21 and focus group transcripts coded using NVivo-9 and recoded using thematic analysis.ResultsOne hundred and sixty-one pre-clerkship medical students from three Canadian medical schools participated in 2012–2013: 59 completed all elements of the RCT, 24 participated in the focus groups. Overall, comparing pre to post results, both groups showed a significant increase in the mean knowledge (quiz) scores and for 5/7 self-assessed competencies (p < 0.05). These quantitative data were triangulated with the focus groups findings that revealed knowledge acquisition with both approaches. There was no statistically significant difference between the two approaches. Participants highlighted their preference for e-learning to introduce new global health knowledge and as a repository of resources. They also mentioned personal interest in global health, online convenience and integration into the curriculum as incentives to complete the e-learning. Beta version e-learning barriers included content overload and technical difficulties.ConclusionsBoth the e-learning and the peer reviewed PDF articles improved global health conceptual knowledge. Many students however, preferred e-learning given its interactive, multi-media approach, access to links and reference materials and its capacity to engage and re-engage over long periods of time.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0421-3) contains supplementary material, which is available to authorized users.

Building a framework for global health learning: an analysis of global health concentrations in Canadian medical schools.

This study set out to explore the current state of global health concentrations in Canadian medical schools and to solicit feedback on the barriers and challenges to implementing rigorous global health concentration programs. A set of consensus guidelines for global health concentrations was drafted through consultation with student and faculty leaders across Canada between May 2011 and May 2012. Drawing on these guidelines, a formal survey was sent to prominent faculty at each of the 14 English-speaking Canadian medical schools. A thematic analysis of the results was then conducted. Overall, the guidelines were strongly endorsed. A majority of Canadian medical schools have programs in place to offer global health course work, extracurricular learning opportunities, local community service-learning, low-resource-setting clinical electives, predeparture training, and postreturn debriefing. Although student evaluation, global health mentorship, and knowledge translation projects were endorsed as important components, few schools had been successful in implementing them. Language training for global health remains contested. Other common critiques included a lack of time and resources, and difficulties in setting standards for student evaluation. The results suggest that these guidelines are appropriate and, at least for the major criteria, achievable. Although many Canadian schools offer individual components, the majority of schools have yet to develop formally structured concentration programs. By better articulating guidelines, a standardized framework can aid in the establishment and refinement of future programs.